Upon further review of the literature and the chronology of the patient's presentation, her condition was most likely due to an immune-mediated reaction to hydrochlorothiazide. [ncbi.nlm.nih.gov]

Case Presentation: A 71 year‐old man presented with two days of a progressively worsening non‐pruritic, erythematous rash over his trunk and extremities. He also noted subjective fevers, fatigue, and decreased urine output. [shmabstracts.com]

• Anemia

  The authors report the clinical and laboratory findings of a patient who had severe immune hemolytic anemia due to hydrochlorothiazide (HCTZ). [ncbi.nlm.nih.gov]

  hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia Hepatic: jaundice, hepatitis Metabolic: dehydration, gout, hyperglycemia, hypokalemia, hypocalcemia, hypovolemia, hypomagnesemia, hyponatremia, hypophosphatemia, hyperuricemia, hypochloremic [medical-dictionary.thefreedictionary.com]

  Hematologic: Aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenia. [americanregent.com]

• Pathologist

  Histologic evaluation of the liver sample was performed by two pathologists. There was evidence of acute cholestatic hepatitis. The perivenular hepatocytes were swollen, with feathery degeneration. [dx.doi.org]

• Nausea

  A 70-year-old woman experienced nausea, diaphoresis, and severe respiratory distress approximately 1/2 hour after taking an Aldactazide tablet. She had experienced a flu-like syndrome after taking a single tablet two weeks previously. [ncbi.nlm.nih.gov]

  Possible side effects of hydrochlorothiazide include nausea, dizziness, and vomiting. (Click Hydrochlorothiazide for more information about how hydrochlorothiazide works, its potential side effects, and general dosing guidelines. [blood-pressure.emedtv.com]

  Digestive: Pancreatitis, jaundice (intrahepatic cholestatic jaundice), diarrhea, vomiting, sialadenitis, cramping, constipation, gastric irritation, nausea, anorexia. [rxlist.com]

  Common hydrochlorothiazide side effects may include: nausea, vomiting, loss of appetite; diarrhea, constipation; muscle spasm; or dizziness, headache. This is not a complete list of side effects and others may occur. [drugs.com]

• Orthostatic Hypotension

  Hypotension with CNS depressants. May interfere with parathyroid tests. Adverse Reactions: Electrolyte disorders (esp. hypokalemia), hyperglycemia, hyperuricemia, photosensitivity, orthostatic hypotension, GI disturbances, adverse lipid values. [empr.com]

  Abstract Hydrochlorothiazide (HCTZ) is a sulfonamide-containing drug with commonly reported adverse effects that include electrolyte abnormalities, orthostatic hypotension, hyperglycemia, and photosensitivity. [ncbi.nlm.nih.gov]

  Orthostatic hypotension may occur during treatment with thiazide diuretics. Orthostatic hypotension can be exacerbated by concurrent use of alcohol, narcotics, or antihypertensive drugs. [pdr.net]

  Orthostatic hypotension may occur during treatment with thiazide diuretics like hydrochlorothiazide.11 Orthostatic hypotension can be exacerbated by concurrent use of alcohol, narcotics, or antihypertensive drugs (see Drug Interactions). [empowerpharmacy.com]

  If orthostatic hypotension is a troublesome symptom (and it may be, especially in the older adult), consult physician for measures that will help tolerate the effect and to prevent falling. [robholland.com]

• Muscle Weakness

  Periodic paralysis (PP) is an autosomal dominant muscle disorder characterized by periodic muscle weakness attacks associated with serum potassium level variations. [ncbi.nlm.nih.gov]

  Diuril Overdose Symptoms of a Diuril overdose may include: Confusion Uneven or irregular heart rate Increased urination Muscle weakness Extreme thirst Inability to urinate Severe lightheadedness Feeling very hot If you suspect an overdose, contact a poison [everydayhealth.com]

  […] heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling; other signs of an an electrolyte imbalance --dry mouth, thirst, nausea, vomiting, drowsiness, feeling weak or restless, muscle [rxlist.com]

  […] heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling; other signs of an an electrolyte imbalance -- dry mouth, thirst, nausea, vomiting, drowsiness, feeling weak or restless, muscle [emedicinehealth.com]

  Vol. 70, Pg. 1163, 1981. man TDLo oral 75mg/kg/30W-I (75mg/kg) BEHAVIORAL: CHANGES IN MOTOR ACTIVITY (SPECIFIC ASSAY) BEHAVIORAL: MUSCLE WEAKNESS GASTROINTESTINAL: OTHER CHANGES Rinsho Shinkeigaku. Clinical Neurology. [chem.nlm.nih.gov]

• Eye Pain

  Get medical help right away if you have any very serious side effects, such as: decrease in vision, eye pain. A very serious allergic reaction to this drug is rare. [webmd.com]

  […] that begins in the stomach area, but may spread to the back joint pain or swelling changes in vision, eye pain, or swelling or redness in or around the eye If you experience a serious side effect, you or your doctor may send a report to the Food and [nlm.nih.gov]

  Call your doctor at once if you have: a light-headed feeling, like you might pass out; eye pain, vision problems; jaundice (yellowing of the skin or eyes); pale skin, easy bruising, unusual bleeding (nose, mouth, vagina, or rectum); shortness of breath [drugs.com]

  […] with symptoms such as: weakness shortness of breath tiredness confusion abnormal heart rate or chest pain producing less urine than normal increased swelling in your legs, ankles, or feet blurred vision, with symptoms such as: eye pain trouble seeing [healthline.com]

• Skin Rash

  A total of 125 patients of 196 (63.8%) started HCTZ prior to developing CTCL lesions, and 35 of 121 (28.0%) started within 1 year of first skin rash. [ncbi.nlm.nih.gov]

  There have been scattered reports of chlorothiazideinduced papular skin rashes, 1 exfoliative dermatitis, 2 purpura 3 and jaundice. 4 In addition to such untoward reactions. .. [nejm.org]

  Your pharmacist may be able to advise you on managing side effects. constipation decreased sexual ability diarrhea dizziness or lightheadedness when getting up from a lying or sitting position headache increased sensitivity of skin to sunlight (skin rash [medbroadcast.com]

  decreased mental activity, irritability, muscle cramps, unusual tiredness or weakness) skin rash or hives stomach pain (severe) with nausea and vomiting tingling or burning sensation unusual bleeding or bruising vision changes yellow eyes or skin Seek [chealth.canoe.com]

• Flushing

  Flush victim's eyes with water or normal saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. [cameochemicals.noaa.gov]

  Signs of high blood sugar like confusion, feeling sleepy, more thirst, more hungry, passing urine more often, flushing, fast breathing, or breath that smells like fruit. [drugs.com]

  However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. [nlm.nih.gov]

• Eczema

  […] based on blood pressure response Interactions Interaction Checker Enter a drug name and chlorothiazide No Interactions Found Interactions Found Serious - Use Alternative Significant - Monitor Closely All Interactions Sort By: Adverse Effects Scaling eczema [reference.medscape.com]

  […] weakness, fatigue 'flu-like' symptoms runny or blocked nose, or sneezing bronchitis sore throat and discomfort when swallowing (pharyngitis) swelling of the hands, feet or ankles back pain urinary tract infection jaundice blurred vision skin rashes or eczema [news-medical.net]

• Insomnia

  Adverse reactions CNS: dizziness, drowsiness, lethargy, headache, insomnia, nervousness, vertigo, asthenia, asterixis, paresthesias, confusion, fatigue, encephalopathy CV: chest pain, orthostatic hypotension, ECG changes, thrombophlebitis, arrhythmias [medical-dictionary.thefreedictionary.com]

  Insomnia. Leg muscle aches. Doctor always saying side effects are just temporary. HA! 5 years is NOT temporary!!! This drug should be banned. [steadyhealth.com]

  If needed, monitor for common amphetamine side effects, including decreased appetite, anxiety, dizziness, dry mouth, irritability, insomnia, nausea, increased blood pressure or increased heart rate. [pdr.net]

• Sexual Dysfunction

  […] disease, hypokalemia, parathyroid disease May aggravate digitalis toxicity Sensitivity reactions may occur with or without history of allergy or asthma Avoid concurrent use with lithium (reduction of lithium dosage by 50% may be necessary) Risk of male sexual [reference.medscape.com]

• Hyperuricemia

  Adverse Reactions: Electrolyte disorders (esp. hypokalemia), hyperglycemia, hyperuricemia, photosensitivity, orthostatic hypotension, GI disturbances, adverse lipid values. Note: Formerly known under the brand name Diuril. [empr.com]

  Safety of losartan in hypertensive patients with thiazide-type hyperuricemia. Kidney Int 1999;56:1879-85. [ebmconsult.com]

  The risk of hyponatremia, hypokalemia, and hyperuricemia associated with HCTZ was lower than with CTD, while the risk of gouty arthritis was similar. [ncbi.nlm.nih.gov]

  Hypokalemia and hyperuricemia were significantly increased in the hydrochlorothiazide group, but the patients were asymptomatic. The total incidence of hypertension was 19.6% in the hydrochlorothiazide group and 21.8% in the placebo group. [jamanetwork.com]

  Contraindications Documented hypersensitivity to hydrochlorothiazide or sulfonamides Anuria Cautions Use with caution in diabetes mellitus, fluid or electrolyte imbalance, hypercholesterolemia, hyperuricemia or gout, hypercalcemia, hypotension, systemic [reference.medscape.com]

• Hyperglycemia

  Adverse Reactions: Electrolyte disorders (esp. hypokalemia), hyperglycemia, hyperuricemia, photosensitivity, orthostatic hypotension, GI disturbances, adverse lipid values. Note: Formerly known under the brand name Diuril. [empr.com]

  […] distress, anorexia, pancreatitis GU: polyuria, nocturia, erectile dysfunction, loss of libido, renal failure Hematologic: anemia, hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia Hepatic: jaundice, hepatitis Metabolic: dehydration, gout, hyperglycemia [medical-dictionary.thefreedictionary.com]

  (Moderate) Thiazide diuretics can decrease insulin sensitivity thereby leading to glucose intolerance and hyperglycemia. Diuretic-induced hypokalemia may also lead to hyperglycemia. [pdr.net]

  Abstract Hydrochlorothiazide (HCTZ) is a sulfonamide-containing drug with commonly reported adverse effects that include electrolyte abnormalities, orthostatic hypotension, hyperglycemia, and photosensitivity. [ncbi.nlm.nih.gov]

  Hyperglycemia occurs and is reduced when K+ supplementation is given with a thiazide. Thiazides may increase LDL cholesterol levels, total cholesterol, and triglycerides. [openanesthesia.org]

• Hypochloremia

  Signs of overdose include those caused by electrolyte depletion (hypokalemia, hypochloremia, hyponatremia) and dehydration resulting from excessive diuresis. If digitalis has also been administered hypokalemia may accentuate cardiac arrhythmias. [druglib.com]

  Hypochloremia and hypokalemia can cause mild metabolic alkalosis. The diuretic efficacy of hydrochlorothiazide is not affected by the acid-base balance of the patient. [empowerpharmacy.com]

  Overdose: Symptoms: Overdosage may lead to excessive diuresis with electrolyte depletion (hypokalemia, hypochloremia, hyponatremia) and dehydration. [rxmed.com]

  […] heteropolycyclic compound Molecular Framework Aromatic heteropolycyclic compounds External Descriptors sulfonamide ( CHEBI:5778 ) organochlorine compound ( CHEBI:5778 ) benzothiadiazine ( CHEBI:5778 ) Ontology Physiological effect Health effect: Health condition: Hypochloremia [hmdb.ca]

• Potassium Decreased

  Inhibits reabsorption of sodium, potassium, and chloride ions. Promotes renal excretion of sodium (and water), bicarbonate, and potassium; decreases renal calcium excretion and supports uric acid excretion. [robholland.com]

  Interestingly, potassium increased slightly with chlorthalidone (0.02 mEq/L) and decreased significantly with HCTZ (0.22 mEq/L, P =0.009). [hyper.ahajournals.org]

• Hypoglycemia

  […] protein loss by the kidney (nephritic syndrome). contraindications Anuria or known hypersensitivity to this drug, to other thiazide medication, or to sulfonamide derivatives prohibits its use. adverse effects Among the more serious adverse effects are hypoglycemia [medical-dictionary.thefreedictionary.com]

  For the treatment of secondary hypoglycemia† due to congenital hyperinsulinemia†. Oral dosage Neonates and Infants 7 to 10 mg/kg/day PO divided twice daily in combination with diazoxide (5 to 20 mg/kg/day PO divided into 3 daily doses). [pdr.net]

Patients with a history of chronic stroke and treatment with angiotensin receptor blockers or angiotensin-converting enzyme inhibitors for essential hypertension were enrolled. [ncbi.nlm.nih.gov]

In this respect, it should be noted that patient adherence to therapeutic regimens, especially in chronic diseases with a significant social impact, is a crucial factor that can also affect the prognosis. [omicsonline.org]

Although there have been 35 reports of cases of hydrochlorothiazide-induced pulmonary edema, the etiology of this adverse reaction remains unknown. [ncbi.nlm.nih.gov]

In our patient, fever, lymphadenopathy, erythroderma, liver and renal involvement, as well as exclusion of other potential etiologies made this diagnosis “definite” by the RegiSCAR scoring system, though classic eosinophilia was not present. [shmabstracts.com]

Author Affiliations From the Drug Epidemiology Unit, Boston University Medical Center; the Department of Epidemiology, Harvard School of Public Health; and the Department of Research Medicine. [dx.doi.org]

Our best findings were also tested for replication in four independent hypertensive samples of European Ancestry, such as GENetics of drug RESponsiveness in essential hypertension, Genetic Epidemiology of Responses to Antihypertensives, NORdic DILtiazem [ncbi.nlm.nih.gov]

Although 12 cases have been reported, the pathophysiology remains obscure. Mitogenic stimulation of the patient's lymphocytes to concanavalin A, phytohemagglutinin, and pokeweed mitogen was assessed. [ncbi.nlm.nih.gov]

Pharmacotherapy: A pathophysiologic approach, 6th ed. McGraw-Hill, New York, pp. 722–723 Google Scholar 13. Mallory A, Kern F Jr (1980) Drug–induced pancreatitis: a critical review. Gastroenterology 78:813–820 Google Scholar 14. [dx.doi.org]

Tocainide prevented myotonia and weakness induced by cooling, but failed to prevent hyperkalemic weakness. Hydrochlorothiazide prevented hyperkalemic weakness, but did not influence symptoms evoked by cooling. [ncbi.nlm.nih.gov]

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). [drugs.com]

Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention [ebmconsult.com]